Provider Demographics
NPI:1164513172
Name:KORB, ROXANA E (LCSW-R)
Entity Type:Individual
Prefix:MRS
First Name:ROXANA
Middle Name:E
Last Name:KORB
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:MRS
Other - First Name:ROXANA
Other - Middle Name:E
Other - Last Name:RUZZA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:2443 LOGUE ST
Mailing Address - Street 2:
Mailing Address - City:NORTH BELLMORE
Mailing Address - State:NY
Mailing Address - Zip Code:11710
Mailing Address - Country:US
Mailing Address - Phone:516-785-2178
Mailing Address - Fax:516-785-2178
Practice Address - Street 1:4610 61ST ST
Practice Address - Street 2:STE H
Practice Address - City:WOODSIDE
Practice Address - State:NY
Practice Address - Zip Code:11377-5766
Practice Address - Country:US
Practice Address - Phone:718-415-4429
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2020-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY069469-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY000150700101OtherHEALTH PLUS
NYP2677456OtherOXFORD HEALTH PLAN
NY298920POtherHIP
NY064971-A37OtherHEALTH FIRST
NY302566OtherMHN
NY7464787OtherAETNA
NY1070480OtherAFFINITY
NY330632OtherWELLCARE